CalOptima Faces Potential Shakeup

ByOctober 5, 2011 at 2:58 PM

After criticizing a controversial restructuring plan for CalOptima, the county's $1.3-billion managed health care agency, county supervisors want to know just what the agency does.

They've asked Health Care Agency officials to report by midmonth on the agency. Supervisors generally are reluctant to serve on the CalOptima board, yet the agency has a budget as large as the county's transportation agency's board, on which all supervisors have a permanent seat.

With President Barak Obama's health reforms taking effect in 2014, county officials expect an additional 100,000 consumers to take part in CalOptima — if it survives.

Only a few years ago, the agency couldn't find any county supervisors interested on serving on its board. "CalOptima is a task, there's no question about that," said supervisors Chairman Bill Campbell.

During the supervisors' Oct. 4 meeting, Supervisor Janet Nguyen expressed her frustrations with serving as the latest appointee to the agency.

Nguyen triggered a political firestorm after proposing an ordinance to appoint health care providers, such as hospitals, to the board instead of members from nonprofit organizations. CalOptima officials and the nonprofits protested.

Nguyen also sought to give herself a permanent seat on the panel by proposing that the supervisor whose district has the most CalOptima members — historically Nguyen's 1st District in central Orange County — have a permanent seat on the board.

Nguyen criticized CalOptima leaders for increasing copays for the poorest members while approving executive bonuses. She also took aim at the nonprofits serving on the board, suggesting they were rubber stamps who often got contracts from the agency.

The Hospital Association of Southern California supported Nguyen's proposal, telling county supervisors that the organization has been concerned for some time about the level of collaboration among stakeholders.

"My leadership feels very strongly that we need to have more of a stakeholder board," said Julie Puentes, regional vice president of the hospital association.

Jean Forbath, one of a series of officials from nonprofits, took issue with Nguyen's accusations, telling supervisors "the nonprofits have nothing to gain on this board. We're there to give a voice."

CalOptima Chairman Edward Kacic took direct aim at Nguyen in a weekend email protesting her ordinance amendment. On Tuesday, he decried the lack of transparency involved in the changes.

"I don't believe there was input from the consumers, or other provider groups," Kacic wrote. He called Nguyen's proposal the "most radical revision of CalOptima proposed since it was started."

Supervisor John Moorlach, who served on CalOptima before Nguyen and is credited by many as the first truly active supervisor on the agency board, advised that "maybe we need to do a workshop on CalOptima."

Moorlach reminded his colleagues that the health care agency is "bigger than OCTA [Orange County Transportation Agency] in terms of revenue."

Moorlach said the agency is very efficient in terms of the services it provides at the price. But he also warned current stakeholders that the county has other options if they aren't happy with CalOptima.

"Maybe we should shut it down," Moorlach said. "It's a middleman. It delivers the services for the state."

Moorlach seconded Supervisor Shawn Nelson's motion to table Nguyen's ordinance. "I'm not going to say CalOptima is perfect, but I don't think this is the road we take," Moorlach said.

After Nelson's motion failed, Nguyen retreated. She suggested that on Oct. 18 the Health Care Agency director brief supervisors and include the option of killing CalOptima.

That plan was adopted by a 4-1 vote, with Nelson dissenting. Nguyen said that she would submit a membership proposal on Nov. 22.